This invention relates to reducing nighttime fears and more particularly to a night light for reducing nighttime fears.
Surprisingly, most children have nighttime fears but most parents don't know it. Nighttime fears cause chronic childhood pain and discomfort, or at their worst, effect learning, health and even brain development. The good thing is that help is both available and very successful. “Fear” is defined as a feeling of dread, anxiety, or profound worry that is triggered by danger and is often accompanied by the urge to hide, fight or escape. “Nighttime fears” are those fears that tend to be associated with the night, darkness, at bedtime or throughout the times a person would typically be sleeping. All children experience fear during childhood including fear of the dark, monsters, and strangers. These fears are considered to be a normal part of child development as long as they are temporary and in proportion to the threat or danger. They are often related to the age of the child (NCS/Harvard 20101). The term “fear” is used in this specification as is commonly defined and includes a psychologic or physical discomfort or anxiety that consciously or unconsciously effects a person.
In younger children, nighttime fears often include fear of the dark, and fear of monsters. Most professionals believe this is related to the developmental stage the child is going through. During this time, the brain is building its ability for imagination, magical thinking and fantasy. Older children tend to have more realistic nighttime fears such as fear of intruders because their brains are developing reality-based thought processes. Just like all child development, fears are not set in stone and there are often transition periods.
Sometimes childhood development is delayed, gets stuck, regresses or several things happen at the same time. For example, research has shown that children with nighttime fear, ages 4-6, demonstrated more fantasy-reality confusion, and their fear was worse if they were less able to differentiate reality from fantasy, compared to children without significant nighttime fears. (Zisenwine 2013).
In addition to changing over time, nighttime fears can be blended together and are therefore sometimes difficult to specify. Fear of the dark may include fear of the unknown, fear of separation, fear of monsters or ghosts, fear of intruders, or fear of injury. They may also be connected to daytime stress, worry, school problems or anxiety related issues (Gregory and Eley 20053).
Although scientists have written about childhood nighttime fears for over 100 years (Charles Darwin 18774), little progress has been made in the areas of raising awareness and providing sound, easy to access treatment until the past few years when researchers have demonstrated significant proven success (Carillo 20055; Gordon 2007,6 2007; Muris 20017).
As with many encounters in life, children are taught to be respectful and cautious of the things not understood. Children need to be cautious in the dark, but they do not need to suffer nightly discomfort or future health consequences from night fears.
In recognizing who suffers from nighttime fears, “It is well known how intensely older children suffer from vague and undefined fears, as from the dark . . . ” (Charles Darwin 18778). Estimates from many published research studies since Darwin's time show how common nighttime fears are in children. The estimates vary depending on how the research was done and which questions the researchers were asking. Fear of the dark and nighttime fears can have several components and therefore estimates of the fears are better described by looking at the study results themselves rather than just giving an approximation, as follows:
73.3% of school children aged 4 to 12 reported nighttime fears (Muris 20019).
Nighttime fear is common with a prevalence of 64.2% in children and adolescents (Gordon 200710).
Between ages 5-8, 33% are specifically afraid of the dark (Cashman 199111).
The literature notes that the peak of these fears occurs in 4-6 year/olds with a gradual reduction after that age (NSC/Harvard 201012). However, in older children, the percentages are still rather high and some experts suggest they actually increase. Children ages 7-11 are in the concrete operational stage of development which allows for the understanding of “cause and effect” and may thus increase their fears. Recent evidence shows a surprisingly elevated percentage of college aged “children” who have fear of the dark. Here are some of the examples in older children:
The most frequently reported sleep problem in ages 6-11 children was fear of falling asleep in the dark (Hvolby 200813).
Children age 7-13 showed fear of the dark was in their top ten list of fears (Muris 199714).
In boys ages 6 to 8.5, up to 18.1% “often” expressed fear of the dark (Rosenberg 201215).
Adolescents recall fear of the dark as being their most frequent fear when they were children (Sipes 198516).
64% of children 8 to 16 years old, admit to nighttime anxieties or fears (Gordon 200717).
(Muris et al 200118) found that nighttime fears become even more frequent in 7 to 9 year olds and then remained relatively stable in 10 to 12 year olds.
A study of 100 college students who were good or poor sleepers found that 46% of the poor sleepers admitted to having current fears of darkness (Carney 201219).
Fear of the dark most often does not appear until age 2 or after (Garber 199320). A study from 1935 (Jersild 193521) asked children age 2-5 to fetch a ball in a dark corridor and 45% of them would not go into the corridor without an adult. Overall, studies show that fear of the dark peaks at different ages for different children, but can clearly be present and frequent until late adolescence or early adulthood.
Thankfully for most children, nighttime fear is normal, mild and transient (Bauer 197622; Ferrari 198623, NSC/Harvard 201024). However there are three important caveats to this observation.
First, “normal” does not mean harmless, inconsequential or painless. Death is a normal part of development too. Pain is a normal part of childbirth. These normal things are not necessarily harmless, inconsequential or painless. Few if any studies have followed the natural progression of nighttime fear for longer than a few months, so “transient” might mean “many years”, the duration is not known with certainty.
Second, persistent fear can actually have life-long consequences by disrupting the developing architecture of the brain (NSC/Harvard 201025). The available data certainly seems to suggest that nighttime fears are persistent, although more research is clearly needed.
Lastly, studies have shown that parents are mostly unaware of the presence of their child's fear, let alone the degree or the amount of associated distress caused. In a study showing that 73.3% of the children reporting nighttime fears, only 34% of their parents were aware of it. The same has been found for other fear-related nighttime occurrences like nightmares. In a study of over 8000 parents and children the researchers found there was a significant underestimation of nightmare frequency in the parents' ratings compared to the children's data. (Schredl 200926) It's not the parents fault. Very little has been done to educate parents about nighttime fears.
So nighttime fear is very common in children, may not be harmless or painless, and parents are largely unaware. The experts say that it is important to address childhood nighttime fears and to take the time to understand nighttime fears.
A paper entitled “Persistent Fear and Anxiety can Affect Young Children's Learning and Development” was written by the National Scientific Council on the Developing Child, thru Harvard University in 2010 (NSC/Harvard 201027). The council consisted of eleven well-credentialed doctors and professors. They formed a multidisciplinary collaboration designed to bring the science of early childhood and early brain development to bear on public decision making, and they were committed to evidenced-based methodologies (in other words: proven or backed up by solid science).
The NSC/Harvard 2010 report says, “threatening circumstances that persistently elicit fear and anxiety predict significant risk for adverse long term outcomes from which children do not recover easily”. The report goes on to note that persistent fear can have life-long consequences by disrupting the developing architecture of the brain. Also, children do not naturally outgrow early learned fear responses over time.
“During typical development, children learn to regulate their responses to mild threats and stresses. However, if young children are exposed to persistent fear and excessive threat during particularly sensitive periods in the developmental process, they may not develop healthy patterns of threat/stress regulation. When they occur, these disruptions do not naturally disappear.”
Of course, the NSC/Harvard 2010 council is discussing a range of fears, anxiety and trauma that children experience, some of which can be very severe. Most nighttime fears may be on the mild end of the severity scale, but on the persistent scale they can be quite high and last for years.
There are additional science-backed reasons to consider addressing the nighttime fears of children:
Fear and worry have been linked to difficulties in daily functioning, social functioning, academic functioning, and low self-esteem, depression, and drug abuse (Zisenwine 201228).
Children age 4-6 with night-time fears are at risk for developing poor sleep quality, those with nighttime fear had greater number of awakenings, shorter total amount of sleep and lower percentage of sleep (Kushnir 201129). Many studies over the past 40 years have linked poor sleep to poor health, and even to poor school performance.
People who sleep with the light on will get less sleep and the sleep they do get is more fragmented and disturbed (Cho 201330).
Children take 54 minutes longer to fall asleep if they are fearful than non-fearful (Mooney 198531).
Darkness phobia causes significant discomfort and has negative effects on the child's daily life and that of his or her family. (Santacruz and Mendez 200632).
Ten percent of children experience severe nighttime fear that seldom disappears spontaneously, impacts overall adjustment, affects the quality of family life and therefore requires intervention (Muris 200133).
Children's nighttime fears cause significant interference with the child's functioning as well as causing much distress for the child and family (Gordon 200734).
Persistent sleep problems in childhood may be an early risk indicator of anxiety in adulthood. (Gregory 200535).
The significance of what it is like for a child to live with daily fear, no matter what the degree, is not easily measured. When adults try to think back to their own childhood memories, the memories are often inaccurate. It is well known that the human brain will distort or even block memories that are painful. The adult brain also has many more coping skills to deal with fear, for example it easily rationalizes that monsters don't exist.
There is a way, however, that adults can better appreciate the discomfort of childhood nighttime fears. They can think about an adult fear (death, illness, heights, public speaking, or other events) and then imagine that feeling of fear being obviously present every night while trying to fall asleep. Once this chronic discomfort is appreciated, it quickly raises the question about what can be done to help children allay nighttime fears.
Apparently, there is no one best approach. All children are different and fears often have multiple influences. Therefore fear treatment of any type may be more effective if it also has multiple features (NSC/Harvard 201036; King 199737).
Most approaches used by experts are successful and long lasting. There are three main steps to consider; awareness, relatively easy approaches, and more involved approaches.
Awareness is important because, as has been mentioned earlier, research has shown that most parents are not aware of their child's nighttime fear. Studies also show that accurate parental perception of the issue increases the chance of successful resolution of the problem (Silverman & Treffers, 200138). Parental focusing on awareness is worthwhile.
Can the child go into a dark room by him/herself? How about that same dark room with an adult? Does the dark seem to affect the child's decisions? Does the child resist having the light turned out when going to bed? Does the child insist on having a night light? Since children are very good at hiding things, parents must ask these questions and look hard for clues.
Listening to, talking with and playing with children are great ways to increase awareness of nighttime fears. Parents should let children know that it is normal to have nighttime fears, and it is just part of growing up for most children. Parents can share with children their own experiences growing up and how they dealt with fear. Parents should consider playing one of the child's favorite games in a darkened (but safe) environment and see how they react. When the parent leaves the room for only a moment, do the children immediately follow?
Having a greater awareness will help guide a parents decisions about addressing a child's nighttime fears. Perhaps nothing needs to be done because the parent determines the night fear is mild and transient. On the other hand, parents may notice a child's continued discomfort or difficulty tolerating the dark and if so it is time to consider some relatively easy approaches to allaying nighttime fears. One or all of the easy approaches may be tried, but it is not wise to overwhelm the child, or the parents, with too many at once.
It comes as no surprise that one of the most effective of the easy approaches for allaying nighttime fears is to use an ordinary night light. The top three nighttime fears are imaginary (monsters), human/animal (intruders) and general fear of the dark. All of these fears can be helped by ambient light. However, ordinary night lights used to provide ambient light have several drawbacks. Sleeping with a night light creates a non-dark environment that tends to interfere with good sleep (Cho 201339). Using an ordinary night light over a period of many nights essentially ignores the problem of night fear caused by darkness since the room is not dark. The hope is that night fear after many nights will eventually go away and the night light can be turned off. While often the night fear will go away, the length of time before the night fear goes away may be excessive or the night fear may not go away at all. Again, research shows that many college students are uncomfortable sleeping in the dark!
For another easy approach, experts recommend the use of a stuffed animal, doll or other toy in one of two ways. In the first way, the toy is given to the child and the child is told that the toy is a protector that will keep the child from danger in the dark. In the second way, the child is told the toy is afraid of the dark, of a monster or of another scary thing and the child should protect the toy from the scary thing. Both the first and second ways at times show significant improvements in overcoming sleep problems and in overcoming nighttime fear. These two ways of using a toy have been shown to be effective particularly for children ages 4-6; with maintenance of that reduction measured 6 months later (Kushnir 201240).
An extension of the stuffed animal or other toy approach is to use both ways at once. Children can then put themselves in the position of being protected and of being a protector. This extension to both ways allows children to both express their fears (“I'm scared and feel protected by the toy”) and also to use their coping skills (“Its ok, I am brave and I can protect the toy; and besides, there are no such thing as ghosts”).
For another easy approach, playing games (play therapy) in a darkened environment can help parents assess a child's nighttime fear and can also be used to help reduce the fear itself. A game that lends itself to being played safely in the dark is used. The light is reduced each time the game is played with the child. The reduction in light is paused or made brighter if the child gets scared. This is a form of progressive desensitization (also called graded exposure) that is used in cognitive behavioral therapy (CBT), which is the most widely used clinical treatment for fears and phobias (Gordon 200741; King 200542).
Play therapy has been shown to help darkness phobia and nighttime fears (Santacruz 200643). Although a parent may not be trained in this specialty area of therapy, parents do know how to play games with their children. While playing, the parent looks for opportunities to talk about the dark. “What does the child's toy think about being in the dark?” “Is Spiderman afraid of monsters?” “What could Barbie do if she was afraid of the dark?” Just the act of talking about darkness and engaging characters familiar to children helps children process their fears and get over them.
Separation fears can be part of nighttime fears. Being separated from the parent or caregiver is scary at certain times of a child's development. One approach is the use of a transitional object (Galligan 199444) that the child can bring to bed like a blanket, toy or something else (tee-shirt, sweater, hat, or other items) that reminds the child of the parent.
Preschoolers are far less likely to be afraid of something if they are able to picture it in a playful and non-threatening way (Sayfan 200945). The fantasy-reality confusion and active imaginations that contribute to nighttime fears can also be used to help children overcome their fears (Zisenwine 201346). This technique is also very successfully used in clinical nightmare treatment and is called imagery rehearsal therapy (Casement 201247). Basically, the story is changed to turn the fearful item into something non-threatening. For example, instead of getting chased and eaten by a monster, the story is change to “The monster is chasing you because Angry Birds is his favorite game and he wants to play Angry Birds with you!” The parent rehearses and presents the new version to the child. The parent helps the child to re-imagine it, “How cool would it be to have a monster as a friend?” The parent collaborates with the child to find a new story that resonates non-fearfully with the child.
Cognitive restructuring is a somewhat similar technique and describes the process of replacing mal-adaptive thinking with functional thinking (Chorpita 200748). The parent helps the child to change the child's thoughts about the scary situation. For example, bravery statements such as “I am brave” and “I can take care of myself in the dark” have commonly been used in studies of nighttime fear (Graziano & Mooney 198049; Kanfer and Karoly 197550). Making those new statements something the child can really relate to and connect with will increase the helpful effects (King 200551; Giebenhain 198452).
Childhood nighttime fears can be linked to the child's environment. Negative information (80%), conditioning (25%) and modeling (13%) all contribute to the origins of nighttime fears (Muris 200153, and others). These results are why many professionals recommend looking at the child's environment (TV, movies, internet, activities, friends, or other things) for potential triggers and to try reducing those felt to be contributory to night fear. Non-fearful and age appropriate activities are the goal. Since each child is unique, a parent is often the best judge of appropriate activities.
Children who have daytime worries, about school, separation from parents or other concerns, are also more likely to fear the dark (Gregory 200554). Parents need to be aware of all possibilities as causes for or contributors to nighttime fear.
Reading books with a child, or letting them read alone, has been shown in several studies to help reduce nighttime fears (Santacruz and Mendez 200655; Mikulas & Coffman 198956; Zisenwine 201357). A parent's judgment is often the best guide for suitable books and reading. In younger children, any story with mild elements of darkness or creatures can help them talk out their fears. These children do better with positive pretense strategy, i.e. imagining the ghost as a “friendly” ghost. For older children, a more direct approach or reality affirmation can work better, i.e. reminding them what is real and not real.
More involved approaches, although more time consuming, complicated and mostly only available professionally, can be extremely helpful so it is worth understanding some basic points.
In Cognitive Behavioral Therapy (CBT), researchers reviewed 29 studies on nighttime fears that had been published in the scientific literature and found that most employed cognitive-behavioral techniques and that most of these studies showed a rapid reduction of nighttime fears. This reduction was typically achieved after only a few sessions with maintenance of gains upon follow-up testing (Gordon 200758; Graziano & Mooney 1980 and 198259). CBT is very commonly and successfully used to treat even severe fears, anxiety, and insomnia. It utilizes a number of techniques (desensitization, emotive imagery, token economy, cognitive self-instruction and restructuring as well as reinforcement procedures or other techniques). The best results come from working with a professional. Although CBT treatments are commonly delivered via written manuals for the patient to work on at home (Sadeh 200560), professional help yields the best outcome. Therefore, often the best first step to access CBT treatment is for a parent to visit with a child's pediatrician.
Sleep Hygiene includes recommendations for developing good sleep habits that are based on 50 years of sleep science and physiology. Sleeping better leaves less time for fear (Ferber 199561). Sleeping worse clearly raises the chance of poor school performance and behavioral problems. Children with fear on average take 54 minutes longer to fall asleep each night (Mooney 198562). Common sleep hygiene recommendations include the following TABLE 1:
TABLE 1Keep very close to the same bedtimes and wake up times every day.Get sufficient amounts of sleep every day (recommended number of  hours for nighttime sleep and for naps often depends on  developmental age).Avoid lots of time awake in bed (more time to worry about monsters!).Follow a regular relaxing routine of activities 20-30 min before bedtime  (winding down allows physical and psychological readiness to  fall asleep more quickly) and if possible avoid bright lights  (light before bedtime tends to awaken the brain).Avoid caffeine after lunchtime and for the rest of the day.Avoid a lot of stimulation (TV, internet, physical activities) in the  30-60 min window before bedtime.Put children to bed drowsy but still awake, so they learn to fall back to  sleep in their own beds if wakened in the middle of the night.Keep the bedroom as dark as is comfortable. A quiet and slightly cool  bedroom is usually best for sleeping.Encourage age appropriate physical exercise and diet - this helps withsleep.Keep a sleep log or sleep diary to track a child's sleep over time. This can  take some effort but can also be very revealing and can help a doctor  guide a child's treatment.
Additional sleep hygiene recommendations as well as information about how and why these are beneficial for sleep can be found at a sleep doctor's office. Just like with CBT, the doctor can provide important personalized details specific to a child's situation.
A great place to get help is at a child's pediatric doctor's office. This may include other appointments, or referrals, or even some testing, but the value returned for spending this time is usually very high. This step is especially important to take if the nighttime fear problem continues despite a parent's efforts, or if it is noticed that a child is developing impaired social, behavioral or school performance.
Nighttime fears are very common in children and although they are most often considered to be a normal part of childhood development that does not mean they are painless or harmless. Also, nighttime fears often last months or even years. Treatment can be successful but limited awareness of the problem and access to effective treatment is likely preventing children from getting this help.
It is well known in fear and phobia treatment that having control over the fear triggering stimulus will lessen the degree of fear. Avoiding the fear promoting stimulus altogether is one of the most common coping strategies employed by phobic persons to reduce their fear, and is a very simple and effective form of control. There is, therefore, a need for devices allowing a person to have immediate control over the light levels in a room (via remote control and in proximity to a controlled remote light) to give a person control over the fear trigging stimulus and thus to reduce the person's level of fear. There is a need to have devices that are able to adjust programming functions such as tapering and dimming to increase the beneficial effect of having control.
In consideration of the above background, there is a need for improved methods and apparatus useful in reducing or eliminating nighttime fears and their resulting discomfort in children.